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NPT: Potential uses in Quantitative Research Tracy Finch

NPT: Potential uses in Quantitative Research Tracy Finch. Institute of Health and Society, Newcastle University. Objectives. To describe the development of a structured research instrument (questionnaire) to measure constructs of the NPM/T in relation to a particular intervention (E-health)

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NPT: Potential uses in Quantitative Research Tracy Finch

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  1. NPT: Potential uses in Quantitative ResearchTracy Finch Institute of Health and Society, Newcastle University

  2. Objectives • To describe the development of a structured research instrument (questionnaire) to measure constructs of the NPM/T in relation to a particular intervention (E-health) • To consider wider issues for use of NPT in Quantitative research

  3. Understanding Normalisation in relation to E-health • ‘Understanding the implementation and integration of e-health services’. Mair, May, Finch, Murray, O’Donnell, Wallace et al. NHS SDO Funded study. (April 2006 – Jan 09). • Focused on barriers and facilitators to use of e-health systems by health professionals within the NHS • One work-package (out of 4) involved developing a structured research instrument to assess ‘readiness’ for e-health • The NPM and NPT framed data collection and analysis throughout project (Began with NPM – finished with NPT)

  4. Objective: To develop a structured, predictive instrument to test the contextual readinessof a health care setting for uptake and routine use of a specific ehealth system by health professionals. Contextual readiness: combination of individual and organisational factors Perspective: Professionals WP3 ‘Technology Adoption Readiness Scale’ (TARS)

  5. TARS Study Structure • Phase 1: Instrument development • included online survey of experts • Phase 2: Generic instrument • ‘factors’ rated in importance • Phase 3: Specific instrument • ‘questions’ about specific e-health system being used

  6. TARS Phase 1: Item development • Aim was to develop an initial item set, using expert review • Generate potential items through translation of construct statements into plain language and single dimensions

  7. Item development: Example….

  8. Phase 1: Expert Survey Survey: • 27 Items for inclusion (IW, RI, SW, CI) • 5pt scale of ‘importance’ (+ ‘don’t know) • Free-text space for ‘any factors missed’ • Conducted electronically Sample: • Authors of reviews relevant to field Recruitment: • Email invitation

  9. Phase 1: Results Response: • 63 completed surveys (25% of 252 invitations presumed received) Data analysis: • Descriptive (mean ratings, correlations) Findings: • Importance of items generally highly endorsed • Most correlations low-moderate (little redundancy) and higher within than across NPM constructs • Free-text responses useful in identifying further factors to include

  10. Phase 2: Development of TARS Generic Aimed to: • Refine factor set using expert survey data • Test ‘relative importance’ from perspective of professionals Revisions to item set (31 Items): • Some items re-worded, dropped or combined • New items added from free-text responses (phase 1) • New items for NPT: Coherence, Cognitive Participation, Reflexive Monitoring

  11. Phase 2: Testing TARS Generic • Survey of health professionals’ perspectives of importance of factors affecting uptake and use of e-health • Sample: Regional NHS Hospitals Trust (potentially 10,000+ respondents). Extensive use of e-Health. • Recruitment: Via site contact (Technical Director) • Response: Extremely low (51 responses) • Analysis: Not particularly useful, but suggestive of different patterns of response between experts and professionals

  12. Phase 3: TARS Specific Aimed to: • Develop a version containing questions framed for an individual’s assessment of a particular e-health system • Test through data collection at (2) different sites: Site 1: Community nurses using PDAs (relatively new) Site 2: Established use of several e-health systems as basis of work (algorithms, information resources, etc)

  13. TARS Specific Instrument • Demographics (eg. Professional role, system/s used, length of time using) • Comfort with using computer-based technology • TARS Items: 30 Items rated from ‘agree strongly’ to ‘disagree strongly’ (7 pt) (Items on hand-out) • ‘Normalisation’ questions: • Whether system was ‘not at all’, ‘partly’, or ‘completely’ in routine use • Perceived likelihood of it becoming routine (5 pt scale)

  14. Phase 3: Sample

  15. Key results: Normalisation Perceptions • Non-parametric (cross-tab) analysis • Groups perceiving e-health as ‘completely’ rather than ‘partly’ routine differed in expected direction: • on 12/30 Items at Site 1 (CI=4; RI=4; IW=1; Co; CP; RM • on 9/30 Items at Site 2 (CI=3; RI=3; SW=1; Co; RM) • At Site 2, comparison of call handlers with nursing & related staff indicated differences on 4 items

  16. Summary of Results of TARS • Development of NPM/T based questionnaire for assessment of individual’s perceptions of factors relating to normalisation of e-health • Operationalising of NPM/T constructs into plain language questions • Support for NPM/T in terms of constructs – patterns of relations between items • Potential of items representing NPM/T constructs for discriminating between levels of perceived normalisation of e-health

  17. TARS - Limitations • Low response rates – insufficient for scale development work (statistical properties) • Constraints of ‘real’ environments: • ‘Readiness’ assessment is dependent on timing and site characteristics • Lack of access to participants/control over survey reminders etc • TARS should be used/tested in further studies, in sites where predictive utility of TARS can be assessed prospectively

  18. Using NPM/T in Quantitative Research: Wider issues • Potential Benefits • Challenges: • Translating theory into plain language • Addressing multiple perspectives • Standardisation vs specification • Operationalising ‘normalisation’ • Summary

  19. Using NPM/T Quantitatively:Potential Benefits • The ‘How much?’ question: • Structured surveys have the potential to collect data efficiently, and on a large scale • The ‘what is likely to happen?’ question: • Surveys, used prospectively, may have some predictive utility with respect to outcomes • Potentially useful in comparative research • Surveys are appealing to practitioners and researchers - facilitate take-up of the Theory!

  20. Challenge 1: Translating constructs into plain language Example: How important are the following factors in affecting the normalisation of e-health….. “…… the extent to which organizational effort is allocated to an ehealth system in proportion to the work that the system is intended to do” (CI) Problem: Multi-dimensional constructs difficult to capture in single questions/statements Possible solutions? • Clear definitions of terms (eg effort) or • Establish understanding of terms of reference (eg agreement on what the system is intended to do?) and use several questions to build understanding

  21. Challenge 2: Addressing multiple perspectives • Questions not to be framed around ‘intention’ – instead reflect judgements about others/the organisation • Which stakeholder groups should be included? How do we combine/weight their ratings? • Need for customising questions (or question sets) for different stakeholder groups

  22. Challenge 3: Standardisation vs specification Quantitative validation of NPT would be facilitated by: • Focused effort on scale development in appropriate settings and with adequate resources, and • Comparative analysis of quantitative research using NPT survey across different settings However..... • Can we develop a useful ‘generic’ NPT based structured survey instrument that is useable across settings? • (and if we do, are we denying the complexity that the NPT embraces?)

  23. Challenge 4: How to operationalise ‘normalisation’? • Does the NPM/T yet define ‘normalisation’ adequately for quantitative measurement of it as an ‘outcome’? • Are ‘perceptions’ of how much an intervention/technology/ practice has become ‘part of everyday work/life’ sufficient to test the constructs of the model? • i.e. Are ‘objective’ measures needed also?

  24. Summary & Final Thoughts • Quantitative use of NPT brings challenges, but potential benefits are huge • TARS represents a useful starting point in developing quantitative use of the NPM/T • Need for more focused effort on scale development and validation (MRC Methodology Programme grant planned) • Other quantitative studies are underway (eg. May, Rapley et al. ‘BSPAR Survey’; Newton et al. Midwifery, Melbourne).

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